Breathing is an involuntary act that keeps a person alive. Human beings, as they evolved, used to co-exist with nature/environment. The quality of air one breaths depends up on the place the person inhabits. Historically, human beings breathed healthy fresh air, as they used to co-exist with environment. Industrialization and urbanization has changed it substantially. Recorded history of industrialization has shown soot spewing chimneys, hazardous work environment that the workers had to contend with. Further advancement of technologies provided for controlled environment through various equipments such as air-conditioning devices that performed different functions such as cooling and heating of air, humidifying and dehumidifying air as required, enabling conditioned working and living environments. Concurrently, new technologies in building sciences, advancement in materials and rapid urbanization have allowed raise/create buildings that are air tight and provide nearly full control over the environment inside the premises. Over the time, more and more houses have got air conditioned, thus having controlled indoor environment. In industrialized and developed countries, people move from conditioned environment in the house to a work place or school or any other public place that is conditioned through an air conditioned car or bus or any other public transport system. In developing countries such as China, India, such practices are growing and the lifestyle is becoming universal. In effect, people live in a controlled environment by choice or by default. When one says indoor, one refers to such environment of staying indoor in a controlled environment. While there is a perception that indoor air is clean and healthy, recent studies have highlighted the problems by calling them Indoor Air Pollution.
Respiratory illness due to pollution is a major subject of discussion. As the wordings suggest, the respiratory illnesses are caused primarily by the quality of air that one inhales. When one refers to Air, there is an implicit understanding that there are no undesirable elements such as pollution in the air. While healthy clean fresh air is essential for a healthy being, it is the pollution that is a culprit in impacting people/individuals. In the US, various institutions including Environment Protection Agency (EPA), Lawrence Berkeley National Laboratory (LBNL) have done enormous amount of research on indoor air pollution. Rapid industrialization, transportation, building industry has caused outside air to be one of the most polluted. The indoor air and outdoor air pollutants could be physical particles and matter such as dust, dander, carpet fibers/fibres and fibroids, or chemicals such as Carbon Monoxide, Carbon di-Oxide, Sulphur Di Oxide, Nitrogen Di Oxide, Ozone or biological particles such as pollen, seeds etc., or could be particulate matter (PM) of various sizes in microns PM10, PM2.5 and PM1.0. The health impacts of these have been extensively documented by WHO/EPA/CDC and other internationally recognized institutions. As a result of these various initiatives have been drawn to create public awareness for both Indoor air Pollution as well as Outdoor Air Pollution. The Indoor Air pollution initiatives typically come under Indoor Air Quality (IAQ) improvement. As regards Outdoor air there are Government initiated steps to sensitize people through Air Quality Index (AQI). This AQI is a One Color, One Number to sensitize people to know the extent of quality of air through different colors—Green, Light Green, Amber, Mauve, Red, Blood Red showing different levels of pollution. The color schema and the number schema vary from country to country. These colors are given for illustrative purpose. Such initiatives are for sensitizing the people to stay alert on the impact of pollution, take required regulatory steps to reduce the extent of pollution, take required precautionary measures individually
The number of individuals globally affected by respiratory illness is a staggering more than 500 mn individuals according to WHO. It is estimated that over 4 Mn die every year due to Acute Respiratory illness. The respiratory illness comes in various forms Common Cold, Asthma, COPD, Sinusitis, Bronchitis and other forms. In the US alone it is estimated that there are more than 53 mn individuals (young, old, children) who are impacted by various forms of respiratory illnesses such as asthma, sinusitis.
Respiratory illness as the name suggests is invariably due to the inhaled air or more specifically, the pollutants, as stated earlier. While the cause and effect of which pollutant may cause which specific human body reaction might not have been exactly established, there is increasing understanding of this. Once with a respiratory illness, naturally one looks for a curative medicine. Doctors prescribe medication—that specifies the medicine, dosage, frequency etc. As regards the cause and effect relationship, the doctors quite often assess the reason as “pollution in the air.” The medication varies from general pills/tablets, to syrups and in cases requiring specific higher care, medicine inhalation through inhalers is prescribed.
Inhaled air varies depending upon place—indoor or outdoor, type of building, extent of exposure etc. In a natural building that has windows and doors relatively open, generally provide relief from the ambient environment. When outside is very hot, the inside temperatures will be lesser and vice versa, namely warmer inside when the ambient environment is very cold. However, the other chemical properties of outside air (ambient air) and inside tend to be similar. The indoor may be, very polluted or very clean depending upon the ambient environment. Now, however, the advancements in construction engineering and building sciences have made many of the buildings (offices and homes) nearly air tight. Newer practices of curtain walled glass (glass exterior) or insulated pre engineering boards or aluminum clad external finishes of buildings do not allow fresh air to infiltrate through the wall. In effect, the indoor environment is distinctly different and is controlled as designed and implemented by the occupants. Lack of fresh air has created various illnesses and World Health Organization (WHO) in their studies categorized such phenomenon as ‘Sick Building Syndrome’—SBS. The resultant poor ‘Indoor Air Quality’ called IAQ has been a subject of serious discussion and debate in the industry and amongst people.
The likelihood of immediate reactions to indoor air pollutants depends on several factors. Age and preexisting medical conditions are two important influences. In other cases, whether a person reacts to a pollutant depends on individual sensitivity, which varies tremendously from person to person. Some people can become sensitized to biological pollutants after repeated exposures, and it appears that some people can become sensitized to chemical pollutants as well.
Certain immediate effects are similar to those from colds or other viral diseases, so it is often difficult to determine if the symptoms are a result of exposure to indoor air pollution. For this reason, it is important to pay attention to the time and place symptoms occur. If the symptoms fade or go away when a person is away from home, for example, an effort should be made to identify indoor air sources that may be possible causes. Some effects may be made worse by an inadequate supply of fresh/outdoor air or from the heating, cooling, or humidity conditions prevalent in the home. Other health effects may show up either years after exposure has occurred or only after long or repeated periods of exposure. These effects, which include some respiratory diseases, heart disease, and cancer, can be severely debilitating or fatal. It is prudent to try to improve the indoor air quality in your home or office even if symptoms are not noticeable.
While pollutants commonly found in indoor air are responsible for many harmful effects, there is considerable uncertainty about what concentrations or periods of exposure are necessary to produce specific health problems. People also react very differently to exposure to indoor air pollutants. Further research is needed to better understand which health effects occur after exposure to the average pollutant concentrations found in homes and which occurs from the higher concentrations that occur for short periods of time.
Quite often CO2 is taken as a proxy for the indoor pollution. Recent studies have increased the importance of understanding the CO2 levels in the room. A recent Study conducted by Dr. Usha Satish, Dr. Mark J Mendell et. al on behalf of National Institutes of Health, US Department of Health and Human Sciences titled “Is CO2 an Indoor Pollutant? Direct Effects of Low-to-Moderate CO2 Concentrations on Human Decision-Making Performance” has found statistically significant decrements in decision making performance.
It is also known that for respiratory illnesses such as asthma the air that one breathes is of extreme relevance. Quite often a person who chokes/gasps for breath rushes outside or changes the location to get a whiff of fresh air. It is known that high CO2 levels increase discomfort for asthma patients. Similarly, it is known that relative humidity of air influences the comfort for asthma patients. Over time and experience a patient learns on the environment where the person is comfortable and would prefer such environment as compared to another environment that the person knows as discomforting. It is also reported that the absenteeism in schools is because of the quality of the indoor air. A lot of contemporary research is going on the need to have lower levels of CO2 in the class room so that the children breathe better quality of air.
Epidemiology is the cornerstone of public health and equips policy decisions by the Government agencies; the study helps identifying the risk factors for a disease and helps in preventive steps for occurrence of such disease/illness. Every person keeps a record of the illness to enable better medical history and treatment for longevity and quality of life. In these days of advanced technology, medical records and genetic history/genealogy analysis is undertaken to arrive at causes for the illness or as important factors for the specific treatment that would be provided to the person. While such level of information is gathered, seldom does a person have a record of the air that he breathed. This collection of data of the individual, the quality of air that he breathed along with the backend analysis of the data collected from several (millions) of individuals would well provide the background data for Epidemiologists to analyze the data that will help formulate health policies. While several factors are important for health, lifestyle or occurrence of an illness, such collected data in conjunction with the ambient weather data, type of activities undertaken by the person would provide enormous insight for the Epidemiologists.
In as far as the equipments such as air conditioners that provide controlled indoor environments for the space are concerned; they are capable of providing the preferred environment. However, the type of setting of such equipments/machines is not a dynamic depending upon the person's requirement, but they are a static based on specific set points such as temperature, relative humidity. As regards Carbon Di oxide levels, these would enable fresh air damper opening based on such set points. In some of the more advanced equipments there are a set of programmed set points or patterns based on which these equipments operate. In a few of the newer control devices, the equipments learn based on the settings and patterns of usage specifically with regard to temperature. However, none of these devices provide a dynamically variable preferred setting based on the persons' preferred setting that correlates to his health. As an example, if an asthmatic person would prefer an air envelope of say Temperature of 23 to 27 deg. C. with a relative humidity of 50% to 65% and a CO2 level of lesser than 600 ppm in the room, the equipment in his house could be told to provide such environment as much as his office equipment or any other place that he would visit. Thus, there is an indispensable link between the air pollution and the dosage of medication for the asthmatic patients.
There are many existing patent application which talk about the smart inhalers. The U.S. Pat. No. 8,807,131 (B1) discloses devices and methods for monitoring a patient's compliance with an asthma inhaler treatment regimen. It is disclosed that the device may be incorporated with a smart phone to provide alerts and notification generated as a result of monitoring of various parameter including the environmental parameters when the patient is taking the inhaler. The device has a predictive indicator for how like patients may respond to similar environments, treatment regimens, and what may trigger attacks in specific patients. But here, the device is not considering the personal environment of the user instead using the generic environmental characteristics. Even though while it appears to capture the patient's environmental parameters, this does not capture environmental parameters continuously. There would be lag between a person inhaling air and its pollutants and the patient's body reacting to such inhaled pollution, so without continuous analysis of inhaled air it is difficult to give accurate predictions. Thus, the prediction may not be that accurate as when the personal environment is tracked continuously for a user. The data collected would not be adequate to evolve a cause and effect relationship. In absence of such data, prognostic predication would not be possible.
The United States patent application no: US2009194104 (A1) discloses a device and method to monitor, track, map, and analyze usage of metered-dose inhalers in real-time. This invention helps in recording the time, date and location, where a medication is used accurately and reliably, and also for transmitting, collecting, and using that data to improve clinical care, disease management, and public health surveillance. This invention doesn't provide a prognostic prediction for the user.
There are many products already in market as smart inhalers such as Smartinhaler™ from Nexus 6, Propeller from Propeller Health, Inspiromatic™ from Inspiro medical and Airsonea™ from Airsonea. Among these there are few products, which provide alert when there is missed dosage or when a person is in a new zone where some other person needed an extra dosage previously then the product gives an alert regarding this. But none of these products provides a predictive and prognostic diagnostics to warn patients in advance about vulnerabilities in new places—whenever they travel. And also to enable effective research with the appropriate data for Doctor on various categories of patients and to assess probabilities of pre-asthmatic.
Thus, there is a need for an intelligent user friendly inhaler that would help patients, to alert them in hostile environments, guide them to learn about their preferred health environment, that would enable the patient to optically medicate (no under dosage or over dosage) live a healthy life by a Smart inhaler system that auto learns, heuristically and through algorithms that captures the micro environment/personal cloud of the air that the individual would seek, preferred settings the personal preferences, dosage of medication, alert in event of deviations from the preferred settings or any change from the expected medication, provide data to the backend that could through a period of time of accumulated data provide valuable health insights to the person as well as act as the database of several individuals health records to enable Health Specialists, Epidemiologists to study and analyze such data to guide the patients who uses the intelligent inhaler.